Endometriosis is one of the most enigmatic and problematic maladies affecting reproductive age women. When male factors are excluded, endometriosis represents the most common cause of reproductive failure in women. Recent evidence suggests that immunologic mechanisms may play a role in the pathogenesis of endometriosis. Immune mechanisms may modulate the development of endometriotic implants and may contribute to the high rate of infertility and spontaneous abortion associated with endometriosis. The objective of this proposal is to investigate the role of cell mediated immunity (CMI) in reproductive failure in women with endometriosis. The incidence of local CMI reactions in the peritoneal fluid of women with endometriosis will be determined by immunohistologic analysis of lymphocytes and macrophage populations and by measurement of levels of lymphokines and monokines in the peritoneal fluid of these women. To perform these studies, the immunoperoxidase technique for detection of characteristic leukocyte markers, and enzyme linked immunosorbent (ELISA) assays for detection of lymphokines and monokines, will be adapted for use with peritoneal fluid. Presence, numbers and concentrations of lymphocyte and macrophage subpopulations and levels of specific lymphokines and monokines from the peritoneal fluid and peripheral blood controls will be correlated with the presence or absence of endometriosis, the stage of the disease and reproductive history. Furthermore, we will continue our basic studies on the effects of soluble products of peritoneal derived leukocytes on reproductive cells and reproductive functions in vitro. These studies may provide insight into new immunological mechanisms underlying reproductive failure in women with endometriosis and new approaches to more effectively diagnose and treat endometriosis- associated reproductive failure.